27例儿童胶质母细胞瘤临床治疗和预后相关因素分析

Clinical treatment and prognostic factors for pediatric glioblastomas: an analysis of 27 cases

目的探讨儿童胶质母细胞瘤的治疗效果及预后相关因素。方法回顾性分析2010年至2017年间收治的27例18岁以下儿童胶质母细胞瘤的手术、放疗与化疗情况,进行长期追踪随访,并对性别、年龄、手术切除程度,以及放化疗4个预后相关因素进行探讨。结果所有患儿均接受了开颅手术治疗。包括21名男性和6名女性。24例肿瘤位于幕上,其余3例位于幕下。22例肿瘤得到全切除,另外5例得到次全切除,围手术期无病人昏迷和死亡。8例患儿在手术后接受了放疗和化疗,9例接受了单纯的化疗,另外10例未进行任何放化疗。本组病例中位生存时间16个月,6个月总生存率81.5%,1年总生存率59.3%,2年总生存率33.3%,5年总生存率14.8%。男性患儿中位生存时间13个月,女性中位生存时间14个月,在性别上无统计学上的显著差异(P=0.87)。0~10岁组患者中位生存时间11个月,11~18岁组患者中位生存时间14个月,在年龄上无统计学显著差异(P=0.63)。单纯手术组中位生存时间8.5个月,而手术+放化疗组中位生存时间为16个月,两组在预后上有显著差异(P=0.0067)。肿瘤全切组中位生存时间为14个月,而次全切除组中位时间为12个月,虽然无明显的统计学差异(P=0.14),但是获得长期生存的病例均来自肿瘤全切患儿。结论儿童胶质母细胞瘤的总体预后较差,生存时间与性别和年龄无关,术后放化疗对延长生存期具有重要的意义。全切肿瘤不能明显延长患儿生存时间,但是患儿获得长期生存的重要前提。

Objective To evaluate the treatment outcome and prognostic factors for pediatric glioblastomas. Methods A retrospective analysis was performed on 27 patients with glioblastomas aged under 18 years admitted from 2010 to 2017 to investigate their data on surgery, radiotherapy, and chemotherapy, as well as follow-up data. Such prognostic factors as sex, age, tumor resection degree, and chemoradiotherapy were analyzed. Results All patients underwent craniotomy. There were 21 boys and 6 girls included in the study. Twenty-four tumors were supratentorial, while 3 tumors were infratentorial. Twenty-two tumors were totally resected, and the other 5 tumors were subtotally resected. No coma or death was observed in the perioperative period. After surgery, 8 patients received radio- therapy and chemotherapy, 9 patients received chemotherapy alone, and the others received no chemotherapy or radiotherapy. The me- dian overall survival （mOS） time was 16 months in all patients. The 6-month, 1-year, 2-year, and 5-year overall survival rates were 81.5% , 59.3%, 33.3%, and 14.8% , respectively. The mOS time was 13 months in boys and 14 months in girls, without significant difference between them （P = 0.87）. The mOS time was 11 months in patients aged 0-10 years and 14 months in those aged 11-18 years, without significant difference between them （P=0.63）. The mOS time was 8.5 months in patients who underwent surgery alone and 16 months in those who underwent surgery and chemoradiotherapy, with a significant difference between them （P=0.0067）. The mOS time was 14 months in patients with total tumor resection and 12 months in those with subtotal tumor resection, without significant difference between them （P=0.14） ; however, all the patients with long-term survival were from those with total tumor resection. Conclusions The prognosis of pediatric glioblastomas is poor on the whole. The overall survival time is not associated with age and sex. Postoperative radiotherapy and chemotherapy can prolong the survival time. Although total tumor resection cannot prolong the survival time, it is the premise of long-term survival.